EPIC Working Groups

The Multi-morbidity Working Group

It has been estimated that the prevalence of multi-morbidity, defined as the occurrence of two or more chronic diseases in an individual, may range from 20%-40% in middle age, and up to 80% in older adults. This is largely attributable to the rise of life expectancy and progress in early detection of diseases and treatment. As a result, people live longer with multiple diseases, as indicated by the Global Burden of Disease Project (1). With an aging European population, the need for population-based health research on multi-morbidity has become a public health priority. In this context, there is need to better understand the determinants and the mechanisms of multi-morbidity.

The EPIC Multi-morbidity Working Group aims to develop a research program that expands current knowledge on the etiology of single morbid conditions to acquire novel scientific evidence on the determinants of multi-morbidity, by exploiting the existing infrastructure of a prospective investigation and a network of scientists. Within EPIC, the occurrence of incident events of type 2 diabetes (T2D) and cardiovascular diseases (CVD) were validated and harmonized within the EPIC InterAct (2) and EPIC-CVD (3) projects, respectively, while cancer onset and mortality are routinely collected by EPIC participating centres. Other incident conditions were the object of research activities in EPIC, including Parkinson′s disease (4) and rheumatoid arthritis.

In order to harmonize the follow-up time for the three conditions, incident cases of cancer and CVD ascertained after 31 December 2007 were censored. In EPIC-CVD centres with a censor date earlier than 31 December 2007, incident cases of cancer and T2D were censored at that date. The WG currently investigates how key risk factors for the incidence of a single adverse event, such as cancer, are related to clustering of non-communicable diseases (NCDs) within individuals. These risk factors include, but are not limited to, obesity, tobacco use, physical inactivity, harmful alcohol use, and unhealthy diets (5).

Other important research areas of the WG are to investigate how cardiometabolic comorbidities, prior to cancer, affect cancer risk, stage at diagnosis, and survival among cancer patients. Cardiometabolic comorbidities may also modify or mediate associations between established cancer risk factors, such as obesity, and risk of cancer and survival after cancer.

Funding of these activities was obtained from the French National Institute of Cancer (INCa) and the World Cancer Research Fund International (WCRF), while other funding opportunities are continuously sought for.


  1. Forouzanfar MH, Afshin A, Alexander LT, Biryukov S, Brauer M, Cercy K, et al. Global, regional, and national comparative risk assessment of 79 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990–2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388(10053):1659–724.

  2. Langenberg C, Sharp S, Forouhi NG, Franks PW, Schulze MB, Kerrison N, et al. Design and cohort description of the InterAct Project: An examination of the interaction of genetic and lifestyle factors on the incidence of type 2 diabetes in the EPIC Study. Diabetologia. 2011;54(9):2272–82.

  3. Danesh J, Saracci R, Berglund G, Feskens E, Overvad K, Panico S, et al. EPIC-Heart: the cardiovascular component of a prospective study of nutritional, lifestyle and biological factors in 520,000 middle-aged participants from 10 European countries. Eur J Epidemiol. 2007;22(2):129–41.

  4. Peters S, Gallo V, Vineis P, Middleton LT, Forsgren L, Sacerdote C, et al. Alcohol Consumption and Risk of Parkinson′s Disease: Data from a Large Prospective European Cohort. Mov Disord. 2020 May 1;n/a(n/a).

  5. Freisling H, Viallon V, Lennon H, Bagnardi V, Ricci C, Butterworth AS, et al. Lifestyle factors and risk of multimorbidity of cancer and cardiometabolic diseases: a multinational cohort study. BMC Med. 2020;18(1):5.

Contact details/Working Group leaders

Pietro Ferrari, PhD
Nutritional Methodology and Biostatistics Group (NMB)
International Agency for Research on Cancer (IARC/WHO)
150 cours Albert Thomas, 69008 Lyon, France

Heinz Freisling, PhD
Nutritional Methodology and Biostatistics Group (NMB)
International Agency for Research on Cancer (IARC/WHO)
150 cours Albert Thomas, 69008 Lyon, France